Healthcare Provider Details

I. General information

NPI: 1487529897
Provider Name (Legal Business Name): MAKAYLA TAZA DAKA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2025
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 158969
NASHVILLE TN
37215-8969
US

IV. Provider business mailing address

11225 OLD FRONTIER RD NW
SILVERDALE WA
98383-8888
US

V. Phone/Fax

Practice location:
  • Phone: 615-652-2344
  • Fax:
Mailing address:
  • Phone: 843-478-1274
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number61568349
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: